As corrective exercise coaches and clinical therapists, the first thing that we are taught about injury prevention is to develop “good” exercise techniques. We are trained to recognise “good technique” as the ability to distribute the load of a specific activity across different structures in a way that both maximises performance and minimises the risk of placing too much stress on any individual structure.
Dr. Hans Selye, a Canadian endocrinologist, once referred to positive stress as adaptative — one that sets up positive changes in our bodies (tissues, bones and organs). Whereas too much structural and neuromuscular stress can prove negative and maladaptive in nature and cause injury or disease. Strength and conditioning expert James Curtis says: “We want Eustress (Eu= good), not Distress!”
With 20 years of clinical exercise practice, my hands-on experience with athletes of all nature and my personal battles with musculoskeletal ailments has taught me that though technique is very important, there are three critical elements when it comes to injury prevention. The 3 Ls — load tolerance, load management and listening to your body while ‘technique’ gets an honorary mention.
Improving load tolerance
A key component of load tolerance is mechanical or structural resilience, which refers to the inherent capacity of the body’s structures (such as bones, muscles, ligaments, and tendons) to absorb forces without breaking down or failing. It encompasses the structural integrity and strength of these tissues. For example, training with resistive forces approximately in the range of one-tenth of the force that causes a fracture trains the bones to be strong enough to resist fracture when subjected to compressive or impact forces, and strong muscles can provide integrity and support as well as sustain force during movements and activities.
Newton’s Third Law addresses reactive forces to actions. The human body generally distributes these reactive forces over large surface areas to dissipate excessive force build up on individual muscles and joints. This process reduces the potential for injury. Load Tolerance extends to how the body transfers forces to other muscles, tendons, ligaments, joint capsules, fascia and bones that lie in series or in parallel to efficiently provide an absorbing platform to prevent pain, injury or dysfunction.
In physical training and sports, improving load tolerance often involves enhancing mechanical strength, but it also encompasses aspects like flexibility, balance, proprioception, and endurance. For example, a well-rounded training programme for an athlete might include strength training to improve mechanical strength and agility drills to enhance load tolerance by improving coordination and stability.
We often hear that certain ethnic populations and races are blessed with “good genetics” that make them inherently stronger than others. Admittedly, genetics do play a role in an individual’s baseline mechanical strength; however, there are other factors as well like lifestyle choices, nutrition and physical activity that are equally important in influencing an individual’s strength levels.
Regular exercise, a balanced diet, and other healthy habits will help improve and maintain mechanical strength throughout one’s life, even in the presence of genetic predispositions or ageing-related changes.
Genetics: The world of speed is dominated by black athletes while East Europeans have always reigned in power and Olympic lifting. There is no doubt that individuals may inherit genes that make them naturally more predisposed to having strong bones and muscles.
Physical activity: Structured strength/resistance training helps stimulate muscle growth, increase bone density, and improve joint stability.
Nutrition: Adequate intake of essential nutrients, including calcium, vitamin D, protein, and other vitamins and minerals, supports bone health, muscle growth, and tissue repair.
Hormones: Hormones, such as testosterone and estrogen, directly impact muscle growth and bone density. Hormonal imbalances can affect an individual’s ability to develop and maintain mechanical strength.
Age: Mechanical strength tends to peak in early adulthood and gradually declines with age. Ageing is associated with a decrease in bone density, muscle mass, and muscle strength. However, regular exercise (especially load-bearing exercises) will mitigate some of these age-related declines.
Gender: Gender can also influence mechanical strength. Generally, men tend to have greater muscle mass and bone density than women, which can result in differences in overall mechanical strength. However, both men and women can improve their strength through training — women can also experience a large reduction of bone mineral density (BMD) during the menopausal transition.
Injury history: Previous injuries or medical conditions can impact mechanical strength. Injuries to bones, muscles, or joints can lead to weakness or reduced functionality in affected areas. Proper rehabilitation and physical therapy are often essential for recovery and restoring strength.
Lifestyle choices: Lifestyle factors such as smoking, excessive alcohol consumption, and poor dietary choices can negatively affect mechanical strength. These behaviours can contribute to bone loss, muscle weakness, and reduced overall physical fitness
Medications and medical conditions: Certain medications and medical conditions can impact bone health and muscle function. For example, long-term use of corticosteroids can lead to bone loss, and conditions like osteoporosis can weaken bones.
Environmental factors: Environmental factors such as exposure to high levels of pollution or toxins can have adverse effects on health, including bone and muscle health.
Handling certain training loads
Training age is a concept used in sports and fitness to describe the number of years an individual has been consistently engaged in structured training or physical activity. Training age is a more reliable indicator of an individual’s capacity and ability to handle certain training loads and intensities compared to their chronological age.
Chronological age versus training age: Training age refers to the number of years that an individual has spent under a structured exercise protocol. Chronological age refers to the number of years a person has been alive. Two people of the same chronological age can have vastly different training ages, depending on their history of training.
Beginner versus experienced: Like all skills and practices, the history of participation will be an influencing factor.
Training adaptations: Training age is closely related to an individual’s physical adaptations and improvements. As someone trains consistently over time, their body undergoes various physiological changes, such as increased strength, endurance, flexibility and skill development. These adaptations contribute to their overall training age. However the more advanced a person is, the higher the chances of adaptative windows being shut. More opportunities for positive adaptations exist in the early years of training.
Training readiness: Training age will help coaches to gauge an individual’s readiness for more advanced training techniques and higher-intensity workouts.
Plateaus and progression: Individuals often experience faster progress and adaptation in the early stages of their training age. As training age increases, our receptiveness and sensitivity to positive changes also decrease. This is when more advanced programming (periodisation) and training strategies become crucial to continue improving.
Injury risk: Individuals with a low training age are generally at a higher risk of injuries when exposed to intense or advanced training protocols prematurely. Training age should be considered when assessing an individual’s injury risk and designing injury prevention strategies.
Sport-specific training: In sports, training age can be used to identify athletes who have spent considerable time developing their skills and fitness for a particular sport. This can be a factor in talent identification and athlete selection.
Individual variation: It’s important to recognise that individuals may progress at different rates, even with the same training age. Genetics, dedication, training quality, and other factors can lead to substantial variation in training outcomes.
Why technique is important
Now we have established what mechanical strength and load tolerance are, it is easy to explain why technique is important. The ability of an athlete to distribute physical (mechanical) stress by distributing the force over the connective tissue network of the body has a lower risk of getting injured. Ultimately, the aim of technique is to distribute the work across multiple structures in a way that facilitates the best performance while not overworking a single structure. Let me try to illustrate this point with an example: An athlete lifting weights overhead has to have the technique to absorb the force and drive the movement with his/her lower body. Trying to use only the shoulders for overhead lifting might expose the athlete to injury in the upper body.
An athlete’s training state refers to their current physical condition, including their fitness level, readiness for competition, and overall preparedness to perform at their best.
Key elements of an athlete’s training state include:
Fitness level: This is a measure of an athlete’s physical capabilities, including strength, endurance, speed, agility, and flexibility. It reflects the training they have undergone and the adaptations their body has made in response to that training.
Fatigue level: Managing recovery through sleep, rest, massage and therapy is critical to ensure that the athlete does not commence a fresh session of training with the additional baggage of fatigue and exhaustion from a previous episode.
Injury status: Now, here is the irony — athletes need to train and they also need to allow injuries to heal. The art of training through an injury needs expert biomechanical and kinesiological knowledge. Coaches and medical professionals need to consider an athlete’s injury status when planning training programs and competition schedules.
Nutrition and hydration: Proper nutrition and hydration are essential for maintaining energy levels, supporting muscle recovery, and overall performance. An athlete’s diet and hydration status can impact their training state.
Mental preparedness: An athlete’s mental state is critical to their performance. Factors such as confidence, focus, and motivation can all influence an athlete’s training state. Mental skills training and psychological support may be used to enhance mental preparedness.
Training progress: Coaches and athletes monitor an athlete’s progress over time to assess their training state. This involves tracking improvements in performance, such as strength, speed and aerobic fitness.
Competition schedule: An athlete’s training state must align with their competition schedule. They need to peak at the right time to perform at their best during important events.
Periodisation: Training programmes are often organized into periods or phases, with varying intensity and volume. The athlete’s training state should align with the specific phase of training they are in.
Environmental factors: Environmental conditions, such as climate and altitude, can also affect an athlete’s training state and performance.
Once we have established an athlete’s training history and their current training state, it is all about managing the loads that we place on the athlete.
Of course, we can’t prevent all injuries because accidents happen. Sometimes things just don’t go to plan, and there isn’t always a clear reason for that. However, constantly varying the load and intensity will keep an educated control over the total stress on the athlete.
Injuries are often caused by overreaching a little beyond the comfort zone or doing too much of the same thing causing a pattern overload on the connective tissues. Therefore, the management of these training variables is, in my opinion, the most critical aspect of injury prevention.
More often than not, giving a specific structure time to heal doesn’t mean a complete cessation of activity. It simply means an adaptation of some of the activities you are doing. And this brings me to my TAB Method.
The TAB Method
The TAB method is a protocol created by coach Jason Curtis after years of working with general clients and athletes and mentoring numerous personal trainers and coaches. The TAB method may seem like the common sense approach and that’s because it is; it makes absolute sense. However, when people get injured, they tend to worry, and that’s normal. But it is key to understand that most of the time, the body just needs a bit of time to heal the affected area, which is often helped by a few adaptations in the exercise regime.
Takeaway aggravators: Initially, get rid of the things that make the injury feel worse during exercise, hours after and the next day (if you keep picking a scab, it will never heal).
Add in exercises that feel good: Load the tissues, increase circulation, and promote healing / add in mobility work to reduce excessive tension
Build resilience to the aggravators: Injury prevention is to “build strength to accommodate strength”. Once initial healing has taken place, we need to progressively build resilience in the tissues.
Always consider what the athlete’s current load tolerance is: It is common to see individuals load a movement and complain of discomfort and pain, and from this, they conclude that the movement is bad for them. However, if the individual can perform a Romanian Deadlift (RDL) with 20kg pain-free, but when they perform it with 100kg, it hurts, then it is not an issue with the movement, but instead, their tissues cannot currently tolerate the 100kgs of load — build load tolerance progressively (progressive overload).
The IIR Protocol
The IIR (Isometric, Isotonic, Reactive) Protocol is also a popular protocol that is used in the athletic world when returning an injured athlete back to sport. Often, athletes will get a great diagnosis and perform the early stages of rehab well. However, they skip the Reactive Stage and return to sport (RTS) unprepared.
In short, athletes often spend weeks performing controlled movements in a gym environment, and then once they are pain-free, they jump straight back onto the field, sprinting, changing direction, and jumping maximally. They then re-injure the same muscle and wonder why — because they haven’t progressively worked back up to rapid eccentric and concentric contractions.
Stage 1: Isometric: Contractions with no change in muscle length — holding the position for 40-plus seconds.
Stage 2: Isotonic: Eccentric (lengthening) and concentric (shortening) contractions — progressively loaded.
Sub-phases: Tempo — specifically slow eccentrics and pauses; RFD (Rate of Force Development) — fast concentric.
Stage 3: Reactive Explosive/Elastic movements such as jumps and throws — plyometrics and ballistic training.
Contractions in response to a stretch: Stretch shortening cycle (SSC).
Stored Elastic Energy: Just like a rubber band, a stretched muscle wants to return to its original length due to the tough elastic properties of tendons (which attach muscle to bone). Imagine the recoil of a thick tendon such as the Achilles tendon — if genetics gift an athlete with a long Achilles tendon and subsequent training toughens the tendon, then this is going to greatly benefit their ability to jump.
The Stretch Reflex: There are receptors in the muscles and tendons (proprioceptors) that detect changes in muscle length (muscle spindles) and muscle tension (Golgi tendon organ). When there is a sudden change in muscle length, the muscle spindles send a signal to the spinal cord and a signal is sent back to contract the muscle. The Golgi tendon organ, on the other hand, can inhibit muscle contraction as a result of excessive tension that could result in injury. With progressive plyometric training, we can learn to capitalize on the stretch reflex (muscle spindles) and reduce the sensitivity of the Golgi tendon organ to maximise our ability to contract forcefully.
Exercises are commonly described as Slow-SSC >250 milliseconds (0.25 seconds) or Fast-SSC <250 milliseconds. A vertical countermovement jump is considered slow-SSC as the duration of the SSC is approximately 500 milliseconds, whereas sprinting is classed as fast-SSC as the duration of the SSC is approximately 80-90 milliseconds.
Ranadeep Moitra is a strength and conditioning specialist and corrective exercise coach
